Skeletal Injuries in Children Mark Latimer Consultant Paediatric Orthopaedic Surgeon Peterborough and Stamford Hospitals NHS Foundation Trust.

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Presentation transcript:

Skeletal Injuries in Children Mark Latimer Consultant Paediatric Orthopaedic Surgeon Peterborough and Stamford Hospitals NHS Foundation Trust

Aims How to Assess, Describe, & Treat Scary Diagnoses Classic Diagnoses by Age Trauma vs Infection How to Spot NAI Cover Your Back

Assessing Young Injured Children Tailor to age Observe function/gait Sit on their parent’s lap Get to their eye level Other side first Palpate bones

Supracondylar Fracture

Scary Supracondylar Fracture

Slipped Upper Femoral Epiphysis

Other Scary Diagnoses Open Fractures/dislocations Compartment Syndrome High Energy Trauma T R A S H Lesions (The Radiographic Appearance Seemed Harmless)

Classic Diagnoses by Age Babies 1-5 year olds 5-10 year olds year olds

Trauma vs Infection (Limping Child) History, examination, tests Septic Arthritis: Kocher et al, JBJS[Am] 81: NWB, fever 38.5C, WBC 12+, ESR 40+ or CRP 10+.

Hip Effusions on Plain Film

NAI and Fractures Kemp AM, et al Patterns of skeletal fractures in child abuse: systematic review. BMJ 337: a1518.

Risk of a Fracture Indicating NAI NAI occurs in: 25-50% fractures children <1yr old Relative risk of NAI (not RTA): Humeral shaft # <3yrs: Femoral shaft # <3 yrs: Rib # 0.71 Skull # under 6 yrs: 0.30

Other High Risk Groups NAI also occurs above average in: Disabled children Delayed presentation Fractures of different ages Lateral third clavicle Scapula fractures Metaphyseal fractures

Recommendations All high risk groups consider paeds review: Children under 18 months old with fracture Under 3 year olds with humeral shaft fracture Under 3 year olds with femoral fracture

Conclusion History tailored to age Diagnosis based upon age Treatment tailored to age Never forget NAI

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